Key points
- Consider EV-D68 infection as a possible cause of unexplained severe acute respiratory illness, especially during summer and fall.
- Report suspected clusters of unexplained severe acute respiratory illness to local and state health departments.
- Follow standard, contact, and droplet precautions to prevent the spread of EV-D68 in healthcare settings.
Introduction
Enterovirus D68 (EV-D68) is one of over 100 non-polio enterovirus types and is a member of the family Picornaviridae.
Clinical features
Consider EV-D68 infection as a possible cause of unexplained severe acute respiratory illness, especially during summer and fall.
EV-D68 infection may be a possibility:
- Even if the patient does not have fever.
- For acute respiratory illness associated with a rhinovirus-positive or enterovirus-positive molecular test.
When to consider AFM
Acute flaccid myelitis (AFM) is an uncommon but serious neurologic condition that can be caused by EV-D68. AFM mostly affects children and causes the muscles and reflexes in the body to become weak.
Consider an AFM diagnosis in patients with:
- Weakness in limbs
- Poor muscle tone
- Decreased reflexes
Consult with an AFM physician
AFM may be difficult for healthcare providers to diagnose and treat. Consider with an infectious disease specialist and a neurologist.
Reducing risk
Be vigilant about preventing the spread of EV-D68 and follow infection control precautions, including standard, contact, and droplet precautions.
Non-enveloped viruses such as EV-D68 may be less susceptible to alcohol than enveloped viruses or vegetative bacteria.
However, alcohol-based hand sanitizer (ABHS), when combined with glove use, offers benefits in:
- Skin tolerance
- Compliance
- Overall effectiveness for a variety of healthcare-associated pathogens
Therefore, after removing and before donning gloves, perform hand hygiene using either ABHS or soap and water.
Testing
Clinicians should recommend laboratory testing to investigate clusters of unexplained severe acute respiratory illness. For enterovirus-positive and rhinovirus-positive specimens, real-time PCR and virus typing by sequencing can determine if EV-D68 is present. EV-D68 typing can be performed by some public health laboratories or by ÐÇ¿ÕÓéÀÖ¹ÙÍø.
Without specialized patient treatment options for EV-D68, testing is unlikely to directly influence clinical management of individual patients. However, it can help to raise awareness of EV-D68 circulation.
Treatment and recovery
No antiviral medications are currently available for people who become infected with EV-D68. Advise your patient about their symptoms and the best way to control them.
Patient counseling
Patients with asthma may have a higher risk for severe symptoms from EV-D68 and other respiratory illnesses.
For patients with asthma
Consider the following when talking with patients:
- Ensure that patients with asthma have an asthma action plan.
- Encourage use of this plan and adherence to prescribed controller medication.
- Recommend that people with asthma experiencing an exacerbation seek care rapidly and early.
Surveillance
ÐÇ¿ÕÓéÀÖ¹ÙÍø has multiple surveillance systems that monitor enteroviruses in the United States.
- National Enterovirus Surveillance System (NESS)
- Acute Respiratory Illness (ARI) Interactive Dashboard
- National Respiratory and Enteric Virus Surveillance System (NRVESS)